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Chanbour H, Chen JW, Bendfeldt GA, Gangavarapu LS, Ahmed M, Chotai S, Luo LY, Berkman RA, Abtahi AM, Stephens BF, Zuckerman SL. Earlier Radiation Is Associated with Improved 1-Year Survival After Metastatic Spine Tumor Surgery. World Neurosurg 2024:S1878-8750(24)00691-0. [PMID: 38677650 DOI: 10.1016/j.wneu.2024.04.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES In patients undergoing metastatic spine surgery, we sought to: 1) report time to postoperative radiation therapy (RT), 2) describe the predictive factors of time to postoperative RT, and 3) determine if earlier postoperative RT is associated with improved local recurrence (LR) and overall survival (OS). METHODS A single-center, retrospective cohort study was undertaken of all patients undergoing spine surgery for extradural metastatic disease and receiving RT within 3-months postoperatively between 02/2010-01/2021. Time to postoperative RT was dichotomized at <1month vs. 1-3months. The primary outcomes were LR, OS, and 1-year survival. Secondary outcomes were wound complication, Karnofsky Performance Scale (KPS), and Modified McCormick Scale (MMS). Regression analyses controlled for age, BMI, tumor size, preoperative RT, preoperative/postoperative chemotherapy, and type of RT. RESULTS Of 76 patients undergoing spinal metastasis surgery and receiving postoperative RT within 3-months, 34(44.7%) received RT within 1month and 42(55.2%) within 1-3months. Patients with larger tumor size (β=-3.58,95%CI=-6.59,-0.57,p=0.021) or new neurological deficits (β=-16.21,95%CI=-32.21,-0.210,p=0.047) had a shorter time to RT. No significant association was found between time to RT and LR or OS on multivariable logistic/Cox regression. However, patients who received RT between 1-3month had a lower odd of 1-year survival compared to those receiving RT within 1month (OR=0.18,95%CI=0.04-0.74,p=0.022). Receiving RT within 1month vs. 1-3month was not associated with wound complications (7.1% vs. 2.9%,p=0.556)(OR=4.40,95%CI=0.40-118.0,p=0.266) or KPS/MMS. CONCLUSIONS Spine surgeons, oncologists, and radiation oncologists should make every effort to start RT within 1 month to improve 1-year survival after metastatic spine tumor surgery.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey W Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | | | - Mahmoud Ahmed
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Richard A Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
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Chanbour H, Roth SG, Chen JW, Uppuganti S, Nyman JS, Ali MA, Bonfield CM, Abtahi AM, Stephens BF, Zuckerman SL. Do Iliac Screws Placed Close to the Sciatic Notch Have Greater Pullout Strength? Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01136. [PMID: 38651901 DOI: 10.1227/ons.0000000000001159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/24/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Optimal iliac screw position in relation to the sciatic notch remains unknown. In 12 cadavers undergoing S2 alar-iliac (S2AI) screw placement, we tested the pullout strength of screws placed in proximity to the sciatic notch (≤5 mm) vs farther away from the sciatic notch (>5 mm). METHODS A biomechanical, cadaver-based study was performed on 12 cadavers undergoing bilateral S2AI screw insertion. The position of the S2AI screw regarding the sciatic notch was dichotomized as ≤5 mm from the sciatic notch on the right side and >5 mm on the left side, confirmed using c-arm fluoroscopy. The primary outcome was the pullout strength of the screw (N). Secondary outcomes were stiffness (N/mm), yield force (N), and work to failure (N mm). Ischial tuberosity was embedded into polymethyl methacrylate and secured to a custom 3-axis vise grip mounted to a 14.5-kN load cell. Pullout testing was performed at 5 mm/min. Force and displacement data were collected at 100 Hz and evaluated using MATLAB. The Mann-Whitney test was performed. RESULTS Of 24 S2AI screws, 3 screws could not be tested because of cement-bone interface failure. A positive though nonsignificant trend of screw pullout strength was found for screws close to the notch compared with those farther from the notch (861.8 ± 340.7 vs 778.7 ± 350.8 N, P = .859). Similarly, screws close to the notch demonstrated a higher trend of stiffness (149.4 ± 145.4 vs 111.34 ± 128.2 N/mm, P = .320) and force to yield (806.9 ± 352.0 vs 618.6 ± 342.9 N, P = .455). Conversely, screws farther from the notch had a higher but similarly nonsignificant area under the force-displacement curve (10 867.0 ± 9565.0 vs 14 196.6 ± 9578.3 N mm, P = .455), which might be due to excess sheer/translation force that could not be reliably quantified. CONCLUSION Although placing S2AI screws ≤5 mm of the sciatic notch provided stronger fixation in 3 of 4 biomechanical testing categories, these results were not statistically significant. Therefore, placing S2AI screws ≤5 mm of the sciatic notch did not provide stronger fixation.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sasidhar Uppuganti
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffry S Nyman
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mir Amaan Ali
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Chen JW, Chanbour H, Bowers M, Bendfeldt GA, Gangavarapu LS, Jonzzon S, Roth SG, Abtahi AM, Zuckerman SL, Stephens BF. Does Preoperative Bilsky Score Predict Outcome Following Surgical Resection of Primary Tumors of the Spine? World Neurosurg 2024; 184:e111-e120. [PMID: 38244684 DOI: 10.1016/j.wneu.2024.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE In patients undergoing surgery for primary bone tumors of the spine, we sought to compare Bilsky score 0-1 versus 2-3 in: 1) preoperative presentation, 2) perioperative variables, and 3) long-term outcomes. METHODS A single-center, retrospective cohort study was undertaken of patients undergoing surgery for extradural, primary bone tumors of the spine between January 2010 and January 2021. The primary exposure variable was Bilsky score, dichotomized as 0-1 versus 2-3. Survival analysis was performed to assess local recurrence (LR) and overall survival (OS). RESULTS Of 38 patients undergoing resection of primary spinal tumors, 19 (50.0%) patients presented with Bilsky 0-1 and 19 (50.0%) Bilsky 2-3 grades. The most common diagnosis was chondrosarcoma (33.3%), followed by chordoma (16.7%). There were 15 (62.5%) malignant tumors. Preoperatively, there was no significant difference in demographics, Karnofsky Performance Scale (KPS) (P > 0.999), or motor deficit (P > 0.999). Perioperatively, no difference was found in operative time (P = 0.954), blood loss (P = 0.416), length of stay (P = 0.641), neurologic deficit (P > 0.999), or discharge disposition (P = 0.256). No difference was found in Enneking resection status (69.2% vs. 54.5%, P = 0.675). Long-term, no differences were found regarding reoperation (P = 0.327), neurologic deficit (P > 0.999), postoperative KPS (P = 0.605) and modified McCormick Scale (MMS) (P = 0.870). No difference was observed in KPS (P = 0.418) and MMS (P = 0.870) at last follow-up. However, patients with Bilsky 2-3 had shorter time to LR (1715.0 vs. 513.0 ± 633.4 days, log-rank; P = 0.002) and shorter OS (2025.0 ± 1165.3 vs. 794.0 ± 952.6 days, log-rank; P = 0.002). CONCLUSIONS Bilsky 2-3 lesions were associated with shorter time to LR and shorter OS. Patients harboring primary spinal tumors with higher grade Bilsky score appear to be at a higher risk for worse outcomes.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mitchell Bowers
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Chen JW, Chanbour H, Gupta R, Izah J, Vaughan WE, Abtahi AM, Zuckerman SL, Stephens BF. Adult versus adolescent idiopathic scoliosis surgery: a meta-analysis of clinical and radiographic outcomes. Eur Spine J 2024; 33:1637-1643. [PMID: 38436875 DOI: 10.1007/s00586-024-08177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/31/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION While the natural history of adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) is well documented in the literature, the impact of age on postoperative outcomes remains an active area of research. We performed a systematic review and meta-analysis to compare patients undergoing surgery for AIS and AdIS with respect to: (1) postoperative Cobb correction, (2) perioperative variables, and (3) postoperative complications. METHODS A systematic literature search was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. INCLUSION CRITERIA studies published between 2002 and 2022, retrospective, and comparing AIS vs. AdIS patients undergoing deformity surgery. The primary outcome was postoperative Cobb correction. Secondary outcomes included estimated blood loss (EBL), operative time, total instrumented levels, length of stay (LOS), and postoperative complications. Random-effects models were performed according to the method of DerSimonian and Laird. RESULTS Of 190 identified articles, 14 fit the inclusion criteria. A total of 1788 patients were included, 1275(71.3%) with AIS, and 513(28.7%) with AdIS. There was a significant age difference between AIS and AdIS (15.3 vs. 36.7 years, mean difference (MD) = 21.3 years, 95%CI = 14.3-28.4,p < 0.001). Mean postoperative Cobb percentage correction was reported in 5 articles and was significantly higher in AIS (68.4%) vs. AdIS (61.4%) (MD = -7.2, 95%CI = -11.6,-2.7,p = 0.001). EBL was not significantly different between AIS and AdIS (695.6 mL vs 817.7 mL,p = 0.204). Furthermore, no difference was found in operative time (MD = 37.9 min,95%CI = -10.7;86.6,p = 0.127), total instrumented level (MD = 0.88,95%CI = -0.7,2.4,p = 0.273), and LOS (MD = 0.5, 95%CI = -0.2;1.2, p = 0.188). Four articles reported postoperative complications in AIS vs AdIS, with no difference in neurological deficit, instrumentation-related complications, and medical complications. CONCLUSION AIS patients had better radiographic correction compared to AdIS. Though no difference was found in perioperative outcomes and complications, these findings emphasize the importance of counseling patients regarding the optimal timing of surgical correction.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rishabh Gupta
- School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Justine Izah
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA.
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Jonzzon S, Chanbour H, Johnson GW, Chen JW, Metcalf T, Lyons AT, Younus I, Liles C, Abtahi AM, Stephens BF, Zuckerman SL. Who Can Be Discharged Home after Adult Spinal Deformity Surgery? J Clin Med 2024; 13:1340. [PMID: 38592140 PMCID: PMC10932028 DOI: 10.3390/jcm13051340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction: After adult spinal deformity (ASD) surgery, patients often require postoperative rehabilitation at an inpatient rehabilitation (IPR) center or a skilled nursing facility (SNF). However, home discharge is often preferred by patients and hsas been shown to decrease costs. In a cohort of patients undergoing ASD surgery, we sought to (1) report the incidence of discharge to home, (2) determine the factors significantly associated with discharge to home in the form of a simple scoring system, and (3) evaluate the impact of discharge disposition on patient-reported outcome measures (PROMs). Methods: A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥ 5-level fusion, sagittal/coronal deformity, and at least 2-year follow-up. Exposure variables included preoperative, perioperative, and radiographic data. The primary outcome was discharge status (dichotomized as home vs. IPR/SNF). Secondary outcomes included PROMs, such as the numeric rating scales (NRSs) for back and leg pain, the Oswestry Disability Index (ODI), and EQ-5D. A subanalysis comparing IPR to SNF discharge was conducted. Univariate analysis was performed. Results: Of 221 patients undergoing ASD surgery with a mean age of 63.6 ± 17.6, 112 (50.6%) were discharged home, 71 (32.2%) were discharged to an IPR center, and 38 (17.2%) were discharged to an SNF. Patients discharged home were significantly younger (55.7 ± 20.1 vs. 71.8 ± 9.1, p < 0.001), had lower rate of 2+ comorbidities (38.4% vs. 45.0%, p = 0.001), and had less hypertension (57.1% vs. 75.2%, p = 0.005). Perioperatively, patients who were discharged home had significantly fewer levels instrumented (10.0 ± 3.0 vs. 11.0 ± 3.4 levels, p = 0.030), shorter operative times (381.4 ± 139.9 vs. 461.6 ± 149.8 mins, p < 0.001), less blood loss (1101.0 ± 977.8 vs. 1739.7 ± 1332.9 mL, p < 0.001), and shorter length of stay (5.4 ± 2.8 vs. 9.3 ± 13.9 days, p < 0.001). Radiographically, preoperative SVA (9.1 ± 6.5 vs. 5.2 ± 6.8 cm, p < 0.001), PT (27.5 ± 11.1° vs. 23.4 ± 10.8°, p = 0.031), and T1PA (28.9 ± 12.7° vs. 21.6 ± 13.6°, p < 0.001) were significantly higher in patients who were discharged to an IPR center/SNF. Additionally, the operating surgeon also significantly influenced the disposition status (p < 0.001). A scoring system of the listed factors was proposed and was validated using univariate logistic regression (OR = 1.55, 95%CI = 1.34-1.78, p < 0.001) and ROC analysis, which revealed a cutoff value of > 6 points as a predictor of non-home discharge (AUC = 0.75, 95%CI = 0.68-0.80, p < 0.001, sensitivity = 63.3%, specificity = 74.1%). The factors in the scoring system were age > 56, comorbidities ≥ 2, hypertension, TIL ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15°. When comparing IPR (n = 71) vs. SNF (n = 38), patients discharged to an SNF were significantly older (74.4 ± 8.6 vs. 70.4 ± 9.1, p = 0.029) and were more likely to be female (89.5% vs. 70.4%, p = 0.024). Conclusions: Approximately 50% of patients were discharged home after ASD surgery. A simple scoring system based on age > 56, comorbidities ≥ 2, hypertension, total instrumented levels ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15° was proposed to predict non-home discharge. These findings may help guide postoperative expectations and resource allocation after ASD surgery.
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Affiliation(s)
- Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
| | - Graham W. Johnson
- School of Medicine, Vanderbilt University, Nashville, TN 37235, USA; (G.W.J.); (A.T.L.)
| | - Jeffrey W. Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Tyler Metcalf
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
| | - Alexander T. Lyons
- School of Medicine, Vanderbilt University, Nashville, TN 37235, USA; (G.W.J.); (A.T.L.)
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
| | - Amir M. Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
| | - Scott L. Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (S.J.); (H.C.); (I.Y.); (C.L.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA;
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Chen JW, Zargari M, Cole MW, Gupta R, Subramanian D, Dawant BM, Li R, Konrad PE, Englot DJ, Dhima K, Bick SK. Electrode position and cognitive outcome following deep brain stimulation surgery. J Neurosurg 2024:1-11. [PMID: 38335523 DOI: 10.3171/2023.11.jns232164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Subthalamic nucleus (STN) and globus pallidus internus (GPI) deep brain stimulation (DBS) effectively treat motor symptoms in Parkinson's disease (PD) but may be associated with cognitive and psychiatric changes in some patients. Evaluation of changes in cognitive and psychiatric symptoms following DBS is complicated by changes in these symptoms that occur as part of the natural disease course. The aim of this study was to evaluate whether electrode position was associated with changes in neurocognitive symptoms in patients who underwent STN and GPI DBS. METHODS A single-institution retrospective cohort study was conducted on patients with PD who underwent DBS from 2008 to 2019. Cognitive and psychiatric outcomes included Beck Depression Inventory II (BDI-II) score, presence of impulsive-compulsive behavior (ICB), Mini-Mental State Examination (MMSE) score, and overall cognitive status grade determined by comprehensive neuropsychology testing (normal, mild impairment, moderate impairment, and dementia). Pre- and postoperative comparisons were performed using a Wilcoxon signed-rank test or paired t-test. Patients with and without cognitive decline were compared using a Mann-Whitney U-test or unpaired t-test. A chi-square test was used for categorical comparisons. RESULTS One hundred thirty patients were included (mean age 62.5 ± 7.9 years). At a mean postoperative follow-up from DBS of 13.0 ± 12.7 (range 6-66) months, there was an improvement in ICB (26.3% preoperatively vs 15.0% postoperatively, p = 0.017), but a decline in MMSE score (28.6 ± 1.6 vs 27.6 ± 2.0, p < 0.001) and overall cognitive status (normal: 66.2% vs 39.2%; mild: 12.3% vs 17.7%; moderate: 21.5% vs 33.1%; dementia: 0.0% vs 10.0%; p < 0.001). Patients undergoing STN DBS had a worse decline in overall cognitive status than patients who underwent GPI DBS (p = 0.006). Postoperative cognitive decline was associated with a more medial electrode position only for patients who underwent STN DBS. CONCLUSIONS Cognitive change was observed in some patients with PD who underwent both GPI and STN DBS, likely due partly to underlying disease progression. Compared with GPI DBS, STN DBS was associated with a greater likelihood of cognitive decline. In STN but not GPI DBS, cognitive decline was associated with medialized electrode position, suggesting modulation of nonmotor STN divisions may contribute to cognitive changes following STN DBS.
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Affiliation(s)
- Jeffrey W Chen
- 1Vanderbilt University, School of Medicine, Nashville, Tennessee
- 2Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Michael Zargari
- 1Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Matthew W Cole
- 1Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Rishabh Gupta
- 3University of Minnesota-Twin Cities Medical School, Minneapolis, Minnesota
| | | | | | - Rui Li
- Departments of5Electrical and Computer Engineering and
| | - Peter E Konrad
- Departments of4Neurosurgery
- 6Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Dario J Englot
- Departments of4Neurosurgery
- 7Biomedical Engineering, Vanderbilt University, Nashville, Tennessee; and
| | | | - Sarah K Bick
- Departments of4Neurosurgery
- 7Biomedical Engineering, Vanderbilt University, Nashville, Tennessee; and
- 9Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee
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Steinle AM, Fogel JD, Chen JW, Chanbour H, Vaughan WE, Karwandyar A, Croft AJ, McDonough J, Chandler PJ, Gardocki R, Zuckerman SL, Abtahi AM, Stephens BF. Determining the Effect of Intraoperative TXA on Postoperative Blood Loss in ACDF. Clin Spine Surg 2024; 37:E18-E23. [PMID: 37559204 DOI: 10.1097/bsd.0000000000001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
STUDY DESIGN Retrospective cohort study using prospectively collected data. OBJECTIVE To determine the effectiveness of intraoperative tranexamic acid (TXA) in anterior cervical discectomy and fusion (ACDF) on postoperative blood loss. SUMMARY OF BACKGROUND DATA TXA has been proven to be a safe and effective agent in reducing blood loss after cervical surgery; however, its efficacy when used intraoperatively for ACDF surgeries had yet to be researched. Currently, there are few studies examining the effects of intraoperative TXA in cervical spinal fusion, and none specifically examining TXA use in ACDF. METHODS A tertiary medical center's prospectively collected spine registry was queried between 1/1/18 and 12/1/21 for all patients who underwent elective ACDF surgery and received a drain postoperatively. Patients were separated into 2 groups; those who had received intraoperative TXA and those who did not. Baseline demographic and operative variables were collected from the registry. The primary outcome was postoperative blood loss over a 24-hour period. Secondary outcomes included total drain output, intraoperative estimated blood loss, operative duration, drain duration, changes in preoperative to postoperative hemoglobin and hematocrit levels, and rate of transfusions, complications, revisions, and reoperations. Univariate and multivariate regression analyses were performed. RESULTS Two hundred eighty-six patients were included. One hundred ninety patients underwent ACDF and did not receive intraoperative TXA, whereas 96 patients underwent ACDF and did receive TXA. There were no differences in any demographic or baseline variables. Multivariate analysis showed intraoperative TXA was associated with shorter drain duration (β=-5.74, 95% CI: -10.9 to -0.53, P =0.031) and reduction in 24-hour drain output (β=-12.2, 95% CI: -19.4 to -4.89, P =0.001) and total drain output (β=-14.0, 95% CI: -22.9 to -5.05, P =0.002). CONCLUSIONS TXA use during ACDF procedures leads to a decrease in perioperative blood loss and faster drain removal. TXA is an effective and safe agent for reducing perioperative blood loss in ACDF surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Jessa D Fogel
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | | | - Hani Chanbour
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Ayub Karwandyar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Andrew J Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Judy McDonough
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Philip J Chandler
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Raymond Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
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Younus I, Chanbour H, Chen JW, Johnson GW, Metcalf T, Lyons AT, Jonzzon S, Liles C, Roth SG, Abtahi AM, Stephens BF, Zuckerman SL. Combined Anterior-Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? J Clin Med 2024; 13:682. [PMID: 38337376 PMCID: PMC10856410 DOI: 10.3390/jcm13030682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: Whether a combined anterior-posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only approach in: (1) preoperative/perioperative variables, (2) radiographic measurements, and (3) postoperative outcomes. Methods: A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary exposure was the operative approach: a combined AP approach or P alone. Postoperative outcomes included mechanical complications, reoperation, and minimal clinically important difference (MCID), defined as 30% of patient-reported outcome measures (PROMs). Multivariable linear regression was controlled for age, BMI, and previous fusion. Results: Among 238 patients undergoing ASD surgery, 34 (14.3%) patients underwent the AP approach and 204 (85.7%) underwent the P-only approach. The AP group consisted mostly of anterior lumbar interbody fusion (ALIF) at L5/S1 (73.5%) and/or L4/L5 (38.0%). Preoperatively, the AP group had more previous fusions (64.7% vs. 28.9%, p < 0.001), higher pelvic tilt (PT) (29.6 ± 11.6° vs. 24.6 ± 11.4°, p = 0.037), higher T1 pelvic angle (T1PA) (31.8 ± 12.7° vs. 24.0 ± 13.9°, p = 0.003), less L1-S1 lordosis (-14.7 ± 28.4° vs. -24.3 ± 33.4°, p < 0.039), less L4-S1 lordosis (-25.4 ± 14.7° vs. 31.6 ± 15.5°, p = 0.042), and higher sagittal vertical axis (SVA) (102.6 ± 51.9 vs. 66.4 ± 71.2 mm, p = 0.005). Perioperatively, the AP approach had longer operative time (553.9 ± 177.4 vs. 397.4 ± 129.0 min, p < 0.001), more interbodies placed (100% vs. 17.6%, p < 0.001), and longer length of stay (8.4 ± 10.7 vs. 7.0 ± 9.6 days, p = 0.026). Radiographically, the AP group had more improvement in T1PA (13.4 ± 8.7° vs. 9.5 ± 8.6°, p = 0.005), L1-S1 lordosis (-14.3 ± 25.6° vs. -3.2 ± 20.2°, p < 0.001), L4-S1 lordosis (-4.7 ± 16.4° vs. 3.2 ± 13.7°, p = 0.008), and SVA (65.3 ± 44.8 vs. 44.8 ± 47.7 mm, p = 0.007). These outcomes remained statistically significant in the multivariable analysis controlling for age, BMI, and previous fusion. Postoperatively, no significant differences were found in mechanical complications, reoperations, or MCID of PROMs. Conclusions: Preoperatively, patients undergoing the combined anterior-posterior approach had higher PT, T1PA, and SVA and lower L1-S1 and L4-S1 lordosis than the posterior-only approach. Despite increased operative time and length of stay, the anterior-posterior approach provided greater sagittal correction without any difference in mechanical complications or PROMs.
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Affiliation(s)
- Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
| | - Jeffrey W. Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Graham W. Johnson
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA; (G.W.J.); (T.M.); (A.T.L.)
| | - Tyler Metcalf
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA; (G.W.J.); (T.M.); (A.T.L.)
| | - Alexander T. Lyons
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA; (G.W.J.); (T.M.); (A.T.L.)
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
| | - Steven G. Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
| | - Amir M. Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Scott L. Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA; (I.Y.); (H.C.); (S.J.); (C.L.); (S.G.R.); (A.M.A.); (B.F.S.)
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Chanbour H, Bendfeldt GA, Chen JW, Gangavarapu LS, Younus I, Roth SG, Chotai S, Abtahi AM, Stephens BF, Zuckerman SL. Comparison of Outcomes in Patients with Cervical Spine Metastasis After Different Surgical Approaches: A Single-Center Experience. World Neurosurg 2024; 181:e789-e800. [PMID: 37923013 DOI: 10.1016/j.wneu.2023.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE In patients undergoing cervical spine surgery for metastatic spine disease, we sought to 1) compare perioperative and oncologic outcomes among 3 different operative approaches, 2) report fusion rates, and 3) compare different types of anterior vertebral body replacement. METHODS A single-center retrospective cohort study of patients undergoing extradural cervical/cervicothoracic spine metastasis surgery between February 2010 and January 2021 was conducted. Operative approaches were anterior-alone, posterior-alone, or combined anterior-posterior, and the grafts/cages used in the anterior fusions were cortical allografts, static cages, or expandable cages. All cages were filled with autograft/allograft. Outcomes included perioperative/postoperative variables, along with fusion rates, functional status, local recurrence (LR), and overall survival (OS). RESULTS Sixty-one patients underwent cervical spine surgery for metastatic disease, including 11 anterior (18.0%), 28 posterior (45.9%), and 22 combined (36.1%). New postoperative neurologic deficit was the highest in the anterior approach group (P = 0.038), and dysphagia was significantly higher in the combined approach group (P = 0.001). LR (P > 0.999), OS (P = 0.655), and time to both outcomes (log-rank test, OS, P = 0.051, LR, P = 0.187) were not significantly different. Of the 51 patients alive at 3 months, only 19 (37.2%) obtained imaging ≥3 months. Fusion was seen in 11/19 (57.8%) at a median of 8.3 months (interquartile range, 4.6-13.7). Among the anterior corpectomies, the following graft/cage was used: 6 allografts (54.5%), 4 static cages (36.3%), and 1 expandable cage (9.0%), with no difference found in outcomes among the 3 groups. CONCLUSIONS The only discernible differences between operative approaches were that patients undergoing an anterior approach had higher rates of new postoperative neurologic deficit, and the combined approach group had higher rates of postoperative dysphagia.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeffrey W Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Dambrino RJ, Chanbour H, Chen JW, Chitale RV, Morone PJ, Thompson RC, Zuckerman SL. In Reply to the Letter to the Editor Regarding "Does Plastic Surgery Involvement Decrease Complications After Cranioplasty? A Retrospective Cohort Study". World Neurosurg 2024; 181:203. [PMID: 38229286 DOI: 10.1016/j.wneu.2023.09.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Croft AJ, Chanbour H, Chen JW, Young MW, Stephens BF. Implant Surface Technologies to Promote Spinal Fusion: A Narrative Review. Int J Spine Surg 2023; 17:S35-S43. [PMID: 38050045 PMCID: PMC10753326 DOI: 10.14444/8559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
The technology surrounding spinal fusion surgery has continuously evolved in tandem with advancements made in bioengineering. Over the past several decades, developments in biomechanics, surgical techniques, and materials science have expanded innovation in the spinal implant industry. This narrative review explores the current state of implant surface technologies utilized in spinal fusion surgery. This review covers various types of implant surface materials, focusing on interbody spacers composed of modified titanium, polyetheretherketone, hydroxyapatite, and other materials, as well as pedicle screw surface modifications. Advantages and disadvantages of the different surface materials are discussed, including their biocompatibility, mechanical properties, and radiographic visibility. In addition, this review examines the role of surface modifications in enhancing osseointegration and reducing implant-related complications and, hopefully, improving patient outcomes. The findings suggest that while each material has its potential advantages, further research is needed to determine the optimal surface properties for enhancing spinal fusion outcomes.
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Affiliation(s)
- Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W Chen
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mason W Young
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Tang CH, Chen JW, Sun T, Duan HY, Sun ZZ, Qi H. [Research advances on size selection and vault prediction of posterior chamber phakic intraocular lens]. Zhonghua Yan Ke Za Zhi 2023; 59:1050-1057. [PMID: 38061907 DOI: 10.3760/cma.j.cn112142-20230109-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Posterior chamber phakic intraocular lens (pIOL) implantation has been widely adopted for the correction of refractive errors. Among pIOLs, the Implantable Collamer Lens is the most common choice. The selection of the appropriate pIOL size and achieving the desired postoperative vault to minimize complications has consistently been a focal point in academic research. With the advancement of ophthalmic biometric measurement technology and the application of artificial intelligence in the field of medicine, numerous new technologies and methods for pIOL size selection and vault prediction have emerged in recent years. This paper provides a comprehensive review on the topic of how to choose the pIOL size and predict the vault.
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Affiliation(s)
- C H Tang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - J W Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - T Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - H Y Duan
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - Z Z Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
| | - H Qi
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
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13
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Bendfeldt GA, Chanbour H, Chen JW, Gangavarapu LS, LaBarge ME, Ahmed M, Jonzzon S, Roth SG, Chotai S, Luo LY, Abtahi AM, Stephens BF, Zuckerman SL. Does Low-Grade Versus High-Grade Bilsky Score Influence Local Recurrence and Overall Survival in Metastatic Spine Tumor Surgery? Neurosurgery 2023; 93:1319-1330. [PMID: 37477422 DOI: 10.1227/neu.0000000000002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal cord compression caused by spinal tumors is measured using the epidural spinal cord compression scale, also known as the Bilsky score. Whether Bilsky score predicts short-/long-term outcomes remains unknown. The objectives were to determine the correlation of Bilsky score 0-1 vs 2-3 with regards to (1) preoperative presentation, (2) perioperative variables, and (3) long-term outcomes. METHODS A single-center, retrospective evaluation of a cohort of patients undergoing metastatic spine surgery was performed between 01/2010 and 01/2021. Multivariable logistic/linear/Cox regression were performed controlling for age, body mass index, race, total decompressed levels, tumor size, other organ metastases, and postoperative radiotherapy/chemotherapy. RESULTS Of 343 patients with extradural spinal metastasis, 92 (26.8%) were Bilsky 0-1 and 251 (73.2%) were Bilsky 2-3. Preoperatively, patients with Bilsky 2-3 lesions were older ( P = .008), presented more with sensory deficits ( P = .029), and had worse preoperative Karnofsky Performance Scale (KPS) ( P = .002). Perioperatively, Bilsky 2-3 patients had more decompressed levels ( P = .005) and transpedicular decompression ( P < .001), with similar operative time ( P = .071) and blood loss ( P = .502). Although not statistically significant, patients with Bilsky 2-3 had more intraoperative neuromonitoring changes ( P = .412). Although rates of complications ( P = .442) and neurological deficit ( P = .852) were similar between groups, patients with Bilsky 2-3 lesions had a longer length of stay ( P = .007) and were discharged home less frequently ( P < .001). No difference was found in 90-day readmissions ( P = .607) and reoperation ( P = .510) Long-term: LR ( P =.100) and time to LR (log-rank; P =0.532) were not significantly different between Bilsky 0-1 and Bilsky 2-3 lesions. However, patients with Bilsky 2-3 lesions had worse postoperative KPS ( P < .001), worse modified McCormick scale score ( P = .003), shorter overall survival (OS) (log-rank; P < .001), and worse survival at 1 year ( P = .012). Bilsky 2-3 lesions were associated with shorter OS on multivariable Cox regression (hazard ratio = 1.78, 95% CI = 1.27-2.49, P < .001), with no significant impact on time to LR (hazard ratio = 0.73, 95% CI = 0.37-1.44, P = .359). CONCLUSION Bilsky 2-3 lesions were associated with longer length of stay, more nonhome discharge, worse postoperative KPS/modified McCormick scale score, shorter OS, and reduced survival at 1 year. Higher-grade Bilsky score lesions appear to be at a higher risk for worse outcomes. Efforts should be made to identify metastatic spine patients before they reach the point of severe spinal cord compression..
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Affiliation(s)
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville , Tennessee , USA
| | | | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Mahmoud Ahmed
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Chen JW, Lof S, Zwart MJW, Busch OR, Daams F, Festen S, Fong ZV, Hogg ME, Slooter MD, Nieveen van Dijkum EJ, Besselink MG. Intraoperative Fluorescence Imaging During Robotic Pancreatoduodenectomy to Detect Suture-Induced Hypoperfusion of the Pancreatic Stump as a Predictor of Postoperative Pancreatic Fistula (FLUOPAN): Prospective Proof-of-concept Study. Ann Surg Open 2023; 4:e354. [PMID: 38144496 PMCID: PMC10735109 DOI: 10.1097/as9.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Abstract
Background A potential downside of robotic pancreatoduodenectomy (RPD) is the lack of tactile feedback when tying sutures, which could be especially perilous during pancreatic anastomosis. Near-infrared fluorescence imaging with indocyanine green (NIRF-ICG) could detect transpancreatic-suture-induced hypoperfusion of the pancreatic stump during RPD, which may be related to postoperative pancreatic fistula (POPF) grade B/C, but studies are lacking. Methods This prospective study included 37 patients undergoing RPD to assess the relation between pancreatic stump hypoperfusion as objectified with NIRF-ICG using Firefly and the rate of POPF grade B/C. In 27 patients, NIRF-ICG was performed after tying down the transpancreatic U-sutures. In 10 'negative control' patients, NIRF-ICG was performed before tying these sutures. Results Pancreatic stump hypoperfusion was detected using NIRF-ICG in 9/27 patients (33%) during RPD. Hypoperfusion was associated with POPF grade B/C (67% [6/9 patients] versus 17% [3/18 patients], P = 0.026). No hypoperfusion was objectified in 10 'negative controls'. Conclusions Transpancreatic-suture-induced pancreatic stump hypoperfusion can be detected using NIRF-ICG during RPD and was associated with POPF grade B/C. Surgeons could use NIRF-ICG to adapt their suturing approach during robotic pancreatico-jejunostomy. Further larger prospective studies are needed to validate the association between transpancreatic-suture-induced hypoperfusion and POPF.
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Affiliation(s)
- Jeffrey W. Chen
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Sanne Lof
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Maurice J. W. Zwart
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Olivier R. Busch
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Freek Daams
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Sebastiaan Festen
- Department of Surgery, OLVG, Location Oost, Amsterdam, The Netherlands
| | - Zhi Ven Fong
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Melissa E. Hogg
- Department of Surgery, Northshore University HealthSystem, Chicago, IL
| | - Maxime D. Slooter
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Els J.M. Nieveen van Dijkum
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
| | - Marc G. Besselink
- From the Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of life, Amsterdam, The Netherlands
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Chotai S, Chen JW, Turer R, Smith C, Kelly PD, Bhamidipati A, Davis P, McCarthy JT, Bendfeldt GA, Peyton MB, Dennis BM, Terry DP, Guillamondegui O, Yengo-Kahn AM. Neurological Examination Frequency and Time-to-Delirium After Traumatic Brain Injury. Neurosurgery 2023; 93:1425-1431. [PMID: 37326424 DOI: 10.1227/neu.0000000000002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Frequent neurological examinations in patients with traumatic brain injury (TBI) disrupt sleep-wake cycles and potentially contribute to the development of delirium. OBJECTIVE To evaluate the risk of delirium among patients with TBI with respect to their neuro-check frequencies. METHODS A retrospective study of patients presenting with TBI at a single level I trauma center between January 2018 and December 2019. The primary exposure was the frequency of neurological examinations (neuro-checks) assigned at the time of admission. Patients admitted with hourly (Q1) neuro-check frequencies were compared with those who received examinations every 2 (Q2) or 4 (Q4) hours. The primary outcomes were delirium and time-to-delirium. The onset of delirium was defined as the first documented positive Confusion Assessment Method for the Intensive Care Unit score. RESULTS Of 1552 patients with TBI, 458 (29.5%) patients experienced delirium during their hospital stay. The median time-to-delirium was 1.8 days (IQR: 1.1, 2.9). Kaplan-Meier analysis demonstrated that patients assigned Q1 neuro-checks had the greatest rate of delirium compared with the patients with Q2 and Q4 neuro-checks ( P < .001). Multivariable Cox regression modeling demonstrated that Q2 neuro-checks (hazard ratio: 0.439, 95% CI: 0.33-0.58) and Q4 neuro-checks (hazard ratio: 0.48, 95% CI: 0.34-0.68) were protective against the development of delirium compared with Q1. Other risk factors for developing delirium included pre-existing dementia, tobacco use, lower Glasgow Coma Scale score, higher injury severity score, and certain hemorrhage patterns. CONCLUSION Patients with more frequent neuro-checks had a higher risk of developing delirium compared with those with less frequent neuro-checks.
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Affiliation(s)
- Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - Robert Turer
- Department of Emergency Medicine, University of Texas Southwestern, Dallas , Texas , USA
| | - Candice Smith
- Division of Trauma and Surgicaxzl Critical Care, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | | | - Philip Davis
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - Jack T McCarthy
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | | | - Mary B Peyton
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - Bradley M Dennis
- Division of Trauma and Surgicaxzl Critical Care, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Douglas P Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Oscar Guillamondegui
- Division of Trauma and Surgicaxzl Critical Care, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Chen JW, Chanbour H, Bendfeldt GA, Gangavarapu LS, Karlekar MB, Abtahi AM, Stephens BF, Zuckerman SL, Chotai S. Palliative Care Consultation Utilization Among Patient Undergoing Surgery for Metastatic Spinal Tumors. World Neurosurg 2023; 178:e549-e558. [PMID: 37532016 DOI: 10.1016/j.wneu.2023.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE In patients undergoing surgery for spinal metastasis, we sought to: (1) describe patterns of palliative care consultation, (2) evaluate the factors that trigger palliative care consultation, and (3) determine the association of palliative care consultation on longer-term outcomes. METHODS A single-center, retrospective, case-control study was conducted for patients undergoing spinal metastasis surgery from February 2010 to January 2021. The primary outcome was receiving a palliative care consultation, and the timing of consultation was divided into same hospital stay consultation, preoperative versus postoperative consultation, and early ( RESULTS Of 363 patients undergoing surgery for spinal metastasis, 62 (17.0%) patients received palliative care consultation during the same hospitalization, 11 (17.7%) were preoperative, and 51 (82.2%) were postoperative. Among same-stay consultations, 32 (51.6%) were early and 30 (48.4%) were late. Palliative care consultation recipients had worse preoperative Karnofsky Performance Scale (KPS) score (P < 0.001), were more likely to have other organ metastases (P = 0.005) or cord compression (P = 0.026), had longer hospitalization (P < 0.001), and were less likely to be discharged home (P < 0.001). Patients presenting with mechanical pain were more likely to receive preoperative consults compared with postoperative (P = 0.029), and earlier compared with later consultations (P = 0.046). Regarding long-term outcomes, patients with same-stay palliative care consultation had significantly shorter overall survival (log-rank; P < 0.001), worse KPS postoperatively (P = 0.017), and worse KPS and Modified McCormick Scale at the last follow-up (P < 0.001). CONCLUSIONS Only 1 in 6 patients received palliative care consultation. Patients receiving same-stay palliative care consultation had more advanced local and systemic disease burden. Increased utilization of palliative care consultation in patients with spine metastasis is needed.
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Affiliation(s)
- Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Mohana B Karlekar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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17
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Chanbour H, Chen JW, Vaughan WE, Abtahi AM, Gardocki RJ, Stephens BF, Zuckerman SL. Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan? World Neurosurg 2023; 178:e657-e665. [PMID: 37543204 DOI: 10.1016/j.wneu.2023.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE In patients undergoing adult spinal deformity (ASD) surgery, we sought to: (1) determine the relationship between dual-energy x-ray absorptiometry (DEXA)-measured bone mineral density (BMD), T-scores, and Hounsfield units (HU), and (2) compare the ability of DEXA-measured BMD, T-scores, and HU to predict mechanical complications and reoperations. METHODS A single-institution retrospective cohort study was undertaken for cases from 2013 to 2017. INCLUSION CRITERIA ≥5-level-fusion, sagittal/coronal deformity, and 2-year follow-up. Multivariable regression controlled for age, body mass index, receiving anabolic medications, and postoperative sagittal vertical axis and pelvic-incidence lumbar-lordosis mismatch. A subanalysis was performed for osteopenic patients (-1 < T-score < -2). RESULTS Of 145 patients undergoing ASD surgery, 72 (49.6%) had both preoperative DEXA and computed tomography scans. Mean DEXA-measured BMD was 0.91 ± 0.52 g/cm2, mean T-score was -1.61 ± 1.03, and mean HU was 153.5 ± 52.8. While no correlation was found between DEXA-measured BMD and HU (r = 0.17, P = 0.144), T-score and HU had a weakly positive correlation (r = 0.31, P = 0.007). Mechanical complications occurred in 48 (66.7%) patients, including 27 (37.5%) proximal junctional kyphosis (PJK), 1 (1.4%) distal junctional kyphosis, 5 (6.9%) implant failure, 30 (41.7%) rod fracture/pseudarthrosis, 42 (58.3%) reoperations, and 16 (22.2%) reoperations due to PJK. No association was found between DEXA-measured BMD or T-scores with mechanical complications or reoperations. While univariate regression showed a significant association between lower HU and PJK (OR 0.98, 95%CI 0.97-0.99, P = 0.011), the significance was lost after multivariable analysis. When considering osteopenic patients (n = 37), only DEXA-measured BMD was an independent risk factor for PJK (OR 0.01, 95%CI 0.00-0.09, P = 0.017), with a threshold of 0.82 g/cm2 (AUC 0.70, 95%CI 0.53-0.84, P = 0.019). CONCLUSIONS Poor correlation was found between the 3 BMD modalities. DEXA-measured BMD may be superior to T-scores and HU in predicting PJK among patients with osteopenia with a threshold of BMD <0.82 g/cm2.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Wilson E Vaughan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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18
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van Ramshorst TME, Chen JW, Hilal MA, Besselink MG. Robot-Assisted versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International Retrospective Cohort Study-Authors' Reply. Ann Surg Oncol 2023; 30:5117-5118. [PMID: 37138168 DOI: 10.1245/s10434-023-13545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Tess M E van Ramshorst
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Jeffrey W Chen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Chen JW, McCandless MG, Bhandarkar AR, Flanigan PM, Lakomkin N, Mikula AL, Michalopoulos GD, Bydon M. The association between bone mineral density and proximal junctional kyphosis in adult spinal deformity: a systematic review and meta-analysis. J Neurosurg Spine 2023; 39:82-91. [PMID: 37029673 DOI: 10.3171/2023.2.spine221101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/28/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK. METHODS A systematic literature search was performed using PubMed and Web of Science keywords of "Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]" AND "Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score. RESULTS A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of -0.69 (95% CI -0.88 to -0.50; I2 = 63.9%, p < 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference -32.35, 95% CI -46.05 to -18.65; I2 = 28.7%, p < 0.001). CONCLUSIONS This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.
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Affiliation(s)
- Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Martin G McCandless
- 2University of Mississippi Medical Center School of Medicine, Jackson, Mississippi
| | | | | | - Nikita Lakomkin
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Mikula
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamad Bydon
- 4Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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Chanbour H, Steinle AM, Chen JW, Waddell WH, Vickery J, LaBarge ME, Longo M, Gardocki RJ, Abtahi AM, Stephens BF, Zuckerman SL. The importance of Hounsfield units in adult spinal deformity surgery: finding an optimal threshold to minimize the risk of mechanical complications. J Spine Surg 2023; 9:149-158. [PMID: 37435329 PMCID: PMC10331500 DOI: 10.21037/jss-22-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/25/2023] [Indexed: 07/13/2023]
Abstract
Background Low bone mineral density (BMD) is a well-established risk factor for mechanical complications following adult spinal deformity (ASD) surgery. Hounsfield units (HU) measured on computed tomography (CT) scans are a proxy of BMD. In ASD surgery, we sought to: (I) evaluate the association of HU with mechanical complications and reoperation, and (II) identify optimal HU threshold to predict the occurrence of mechanical complications. Methods A single-institution retrospective cohort study was undertaken for patients undergoing ASD surgery from 2013-2017. Inclusion criteria were: ≥5-level fusion, sagittal/coronal deformity, and 2-year follow-up. HU were measured on 3 axial slices of one vertebra, either at the upper instrumented vertebra (UIV) itself or UIV ±4 from CT scans. Multivariable regression controlled for age, body mass index (BMI), postoperative sagittal vertical axis (SVA), and postoperative pelvic-incidence lumbar-lordosis mismatch. Results Of 145 patients undergoing ASD surgery, 121 (83.4%) had a preoperative CT from which HU were measured. Mean age was 64.4±10.7 years, mean total instrumented levels was 9.8±2.6, and mean HU was 153.5±52.8. Mean preoperative SVA and T1PA were 95.5±71.1 mm and 28.8°±12.8°, respectively. Postoperative SVA and T1PA significantly improved to 61.2±61.6 mm (P<0.001) and 23.0°±11.0° (P<0.001). Mechanical complications occurred in 74 (61.2%) patients, including 42 (34.7%) proximal junctional kyphosis (PJK), 3 (2.5%) distal junctional kyphosis (DJK), 9 (7.4%) implant failure, 48 (39.7%) rod fracture/pseudarthrosis, and 61 (52.2%) reoperations within 2 years. Univariate logistic regression showed a significant association between low HU and PJK [odds ratio (OR) =0.99; 95% confidence interval (CI): 0.98-0.99; P=0.023], but not on multivariable analysis. No association was found regarding other mechanical complications, overall reoperations, and reoperations due to PJK. HU below 163 were associated with increased PJK on receiver operating characteristic (ROC) curve analysis [area under the curve (AUC) =0.63; 95% CI: 0.53-0.73; P<0.001]. Conclusions Though several factors contribute to PJK, it appears that 163 HU may serve as a preliminary threshold when planning ASD surgery to mitigate the risk of PJK.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony M. Steinle
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W. Chen
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - William Hunter Waddell
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Vickery
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew E. LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Longo
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raymond J. Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M. Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L. Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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21
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Chen JW, Wang Y, Yan YT, Xiong WJ, Wang TY, Liu W, Zou DH, Qiu LG, Yi SH. [Clinical and biological features and prognosis of patients with leukemic non-nodal mantle cell lymphoma]. Zhonghua Yi Xue Za Zhi 2023; 103:1746-1752. [PMID: 37305933 DOI: 10.3760/cma.j.cn112137-20220928-02043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To investigate the clinical, biological and prognostic characteristics of leukemic non-nodal mantle cell lymphoma (nnMCL). Methods: The clinical data of 14 patients with nnMCL and 238 patients with classical mantle cell lymphoma (cMCL) in Blood Diseases Hospital, Chinese Academy of Medical Sciences from November 2000 to October 2020 were retrospectively analyzed. Among the 14 patients with nnMCL, there were 9 males and 5 females, with the age [M (Q1, Q3)] of 57.5 (52.3, 67.0) years. Among the 238 patients with cMCL, there were 187 males and 51 females, with the age of 58.0 (51.0, 65.3) years. The clinical and biological characteristics of the two groups were recorded and compared. Follow-up and efficacy evaluation were conducted by re-examination during hospital stay and telephone follow-up and so on. Results: The proportion of CD200 expression in nnMCL patients was 8/14, which was higher than that in cMCL patients [14.6% (19/130)] (P=0.001). The proportion of CD23 expression in nnMCL patients was 8/14, which was higher than that in cMCL patients [13.5% (23/171)] (P<0.001). The proportion of CD5 expression in nnMCL patients was 10/14, which was lower than that in cMCL patients [97.4% (184/189)] (P=0.001). The proportion of CD38 expression in nnMCL patients was 4/14, which was lower than that in cMCL patients [69.6% (112/161)] (P=0.005). The expression proportion of sex-determining region of Y chromosome-related high-mobility-group box 11 (SOX11) in nnMCL patients was 1/5, which was lower than that in cMCL patients [77.9% (60/77)] (P=0.014). The proportion of immunoglobulin heavy chain variable region (IGHV) mutations in nnMCL patients was 11/11, which was higher than that in cMCL patients [26.0% (13/50)] (P<0.001). As of April 11, 2021, the follow-up time for nnMCL and cMCL patients was 31 (8-89) months and 48 (0-195) months, respectively. Among the 14 nnMCL patients, 6 patients were still under observation, and 8 patients were treated. The overall response rate (ORR) was 8/8, including 4 patients with complete remission and 4 patients with partial response. The median overall survival and median progression-free survival were not reached in nnMCL patients. In the cMCL group, 50.0% (112/224) patients achieved a complete response, 24.6% (55/224) patients achieved a partial response, and ORR was 74.6% (167/224). There was no statistically significant difference in ORR between the two groups (P=0.205). Conclusions: nnMCL patients have an indolent progression, with higher expression rates of CD23 and CD200 and lower expression rates of SOX11, CD5 and CD38. Most patients have IGHV mutations, with a relatively good prognosis, and"watch and wait"approach is an optional treatment.
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Affiliation(s)
- J W Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y T Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W J Xiong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - T Y Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - W Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - D H Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - L G Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - S H Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Department of Lymphoma and Myeloma, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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Chen JW, Longo M, Chanbour H, LaBarge ME, Abtahi AM, Stephens BF, Zuckerman SL. Cranially Directed Upper Instrumented Vertebrae Screw Angles Are Associated With Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2023; 48:710-719. [PMID: 36728801 DOI: 10.1097/brs.0000000000004573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To evaluate the impact of the upper instrumented vertebral (UIV) screw angle in adult spinal deformity (ASD) surgery on: (1) proximal junctional kyphosis/failure (PJK/F), (2) mechanical complications and radiographic measurements, and (3) patient-reported outcome measures (PROMs). SUMMARY OF BACKGROUND DATA The effect of UIV screw angle in ASD surgery on patient outcomes remains understudied. MATERIALS AND METHODS A single-institution, retrospective study was undertaken from 2011 to 2017. UIV screw angle was trichotomized into positive: cranially directed screws relative to the superior endplate (2°≤θ), neutral: parallel to the superior endplate (-2°<θ<2°), and negative: caudally directed screws relative to the superior endplate (-2°≥θ). The primary outcome was PJK/F. Secondary outcomes included remaining mechanical complications, reoperation, and PROMs: Oswestry Disability Index, Numeric Rating Scale (NRS) back/leg, and EuroQol. Regression controlled for age, body mass index, postoperative sagittal vertical axis (SVA), and pelvic incidence lumbar-lordosis mismatch. RESULTS Among 145 patients undergoing ASD surgery, UIV screw angles were 35 (24.1%) cranially directed, 24 (16.6%) neutral, and 86 (59.3%) caudally directed. PJK occurred in 47(32.4%) patients. Positive screws were independently associated with increased PJK [odds ratio (OR)=4.88; 95% CI, 1.85-13.5, P =0.002] and PJF (OR=3.06; 95% CI, 1.32-12.30, P =0.015). Among 108 (74.5%) patients with lower thoracic UIV, PJK occurred in 38 (35.1%). Cranially directed screws were independently associated with an increased odds of PJK (OR=5.56; 95% CI, 1.86-17.90, P =0.003) with a threshold of 0.2° (area under the curve =0.65; 95% CI, 0.54-0.76, P <0.001), above which the risk of PJK significantly increased. No association was found between positive screw angle and PJF (OR=3.13; 95% CI, 0.91-11.40, P =0.073). Because of the low number of patients with an upper thoracic UIV (N=37, 25.5%), no meaningful conclusions could be drawn from this subgroup. There was no association between UIV screw angle and remaining mechanical complications, reoperations, postoperative SVA and T1-pelvic angle, or PROMs. CONCLUSIONS Cranially directed UIV screw angles increased the odds of PJK in patients with lower thoracic UIV. Meticulous attention should be paid to the lower thoracic UIV screw angle to mitigate the risk of PJK in ASD.
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Affiliation(s)
- Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, TN
| | - Michael Longo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
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23
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Chen JW, van Ramshorst TME, Lof S, Al-Sarireh B, Bjornsson B, Boggi U, Burdio F, Butturini G, Casadei R, Coratti A, D'Hondt M, Dokmak S, Edwin B, Esposito A, Fabre JM, Ferrari G, Ftériche FS, Fusai GK, Koerkamp BG, Hackert T, Jah A, Jang JY, Kauffmann EF, Keck T, Manzoni A, Marino MV, Molenaar Q, Rau EP, Pessaux P, Pietrabissa A, Soonawalla Z, Sutcliffe RP, Timmermann L, White S, Yip VS, Zerbi A, Hilal MA, Besselink MG. ASO Visual Abstract: Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer-An International Retrospective Cohort Study. Ann Surg Oncol 2023; 30:3035-3037. [PMID: 36809605 DOI: 10.1245/s10434-023-13161-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Jeffrey W Chen
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tess M E van Ramshorst
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Sanne Lof
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bilal Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Bergthor Bjornsson
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Fernando Burdio
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | | | - Riccardo Casadei
- Department of Surgery, Sant'Orsola Malphigi Hospital, Bologna, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Bjørn Edwin
- The Intervention Center, Department of Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Jean M Fabre
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | | | - Fadhel S Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Giuseppe K Fusai
- HPB & Liver Transplant Unit, Royal Free London, London, United Kingdom
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Asif Jah
- Department of HPB Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | | | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco V Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Patrick Pessaux
- Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, Birmingham, UK
| | | | - Steven White
- Department of Surgery, The Freeman Hospital, Newcastle Upon Tyne, Newcastle, UK
| | - Vincent S Yip
- Department of HPB Surgery, The Royal London Hospital, Bartshealth NHS Trust, London, UK
| | - Alessandro Zerbi
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marc G Besselink
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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Dambrino RJ, Liles DC, Chen JW, Chanbour H, Koester SW, Feldman MJ, Chitale RV, Morone PJ, Chambless LB, Zuckerman SL. The cost of a plastic surgery team assisting with cranioplasty. Clin Neurol Neurosurg 2023; 228:107711. [PMID: 37030111 DOI: 10.1016/j.clineuro.2023.107711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Cranioplasty is a commonly performed neurosurgical procedure that restores cranial anatomy. While plastic surgeons are commonly involved with cranioplasties, the cost of performing a cranioplasty with neurosurgery alone (N) vs. neurosurgery and plastic surgery (N + P) is unknown. METHODS A single-center, multi-surgeon, retrospective cohort study was undertaken on all cranioplasties performed from 2012 to 22. The primary exposure variable of interest was operating team, comparing N vs. N + P. Cost data was inflation-adjusted to January 2022 using Healthcare Producer Price Index as calculated by the US Bureau of Labor Statistics. RESULTS 186 patients (105 N vs. 81 N + P) underwent cranioplasties. The N + P group has a significantly longer length-of-stay (LOS) 4.5 ± 1.6days, vs. 6.0 ± 1.3days (p < 0.001), but no significant difference in reoperation, readmission, sepsis, or wound breakdown. N was significantly less expensive than N + P during both the initial cranioplasty cost ($36,739 ± $4592 vs. $41,129 ± $4374, p 0.014) and total cranioplasty costs including reoperations ($38,849 ± $5017 vs. $53,134 ± $6912, p < 0.001). Univariable analysis (threshold p = 0.20) was performed to justify inclusion into a multivariable regression model. Multivariable analysis for initial cranioplasty cost showed that sepsis (p = 0.024) and LOS (p = 0.003) were the dominant cost contributors compared to surgeon type (p = 0.200). However, surgeon type (N vs. N + P) was the only significant factor (p = 0.011) for total cost including revisions. CONCLUSIONS Higher costs to N + P involvement without obvious change in outcomes were found in patients undergoing cranioplasty. Although other factors are more significant for the initial cranioplasty cost (sepsis, LOS), surgeon type proved the independent dominant factor for total cranioplasty costs, including revisions.
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Affiliation(s)
- Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - D Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stefan W Koester
- Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael J Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderilt Policy and Costs in Surgery (VPaCS) Research Center, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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25
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Chen JW, Martini M, Pennington Z, Lakomkin N, Mikula AL, Sebastian AS, Freedman BA, Bydon M, Elder BD, Fogelson JL. Characterizing the Current Clinical Trial Landscape in Spinal Deformity: A Retrospective Analysis of Trends in the Clinicaltrials.gov Registry. World Neurosurg 2023:S1878-8750(23)00297-8. [PMID: 36906083 DOI: 10.1016/j.wneu.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION The management of adult spinal deformity (ASD) relies upon retrospective data, but there have been calls for prospective trials to improve the evidentiary base. This study sought to define the state of the spinal deformity clinical trials and highlight trends to guide future research. METHODS The Clinicaltrials.gov database was queried for all ASD trials initiated since 2008. ASD was defined as adults (>18 years) and defined by the trial. All identified trials were categorized by enrollment status, study design, funding source, start and completion dates, country, outcomes examined, among many other study characteristics. RESULTS Sixty trials were included, of which 33(55.0%) started within the past 5 years of the query date. Most trials were sponsored by academic centers(60.0%) followed by industry(48.3%). Notably, 16(27%) trials had multiple funding sources, all included collaboration with an industry entity. Only one trial had funding from a government agency. There were 30(50%) interventional and 30(50%) observational studies. The average time to completion was 50.8±49.1 months. A total of 23(38.3%) investigated a new procedural innovation, while 17(28.3%) studies examined the safety or efficacy of a device. Study publications were associated with 17(28.3%) trials in the registry. CONCLUSION The number of trials has increased significantly over the past five years, with the bulk of trials being funded by academic centers and industry, and a notably lack by government agencies. Most trials focused on device or procedural investigation. Despite growing interest in ASD clinical trials, there remain many points for improvement in the current evidentiary base.
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Affiliation(s)
- Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville, TN.
| | - Michael Martini
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
| | - Nikita Lakomkin
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
| | | | | | | | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN
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26
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Chen JW, Shlobin NA, Bhebhe A, Zhao S, Shannon CN, Sichizya K, Bonfield CM, Reynolds RA. Local conceptions of the role of folate in neural tube defects in Zambia. J Neurosurg Pediatr 2023; 31:268-274. [PMID: 36681960 DOI: 10.3171/2022.11.peds22217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In sub-Saharan Africa, neural tube defects (NTDs) are the second most common birth defect, occurring eight times more frequently than in the US. The objective of this study was to assess baseline Zambian caregiver understanding of folate and NTDs and the effectiveness of an NTD prevention educational program. METHODS This prospective survey-based study included Zambian caregivers of children born with NTDs who completed pre- and post-educational program surveys between January 2020 and January 2021. The verbal survey was administered in English or local Zambian dialects. The 1-hour educational program administered by local Zambian research nurses sought to facilitate understanding of the direct relationship between prenatal folate supplementation and NTDs. RESULTS Sixty-one eligible caregivers with a median age of 20 (IQR 24-29) years completed the survey. Participants were predominantly from regions outside of Lusaka Province (68%, 41/60) rather than the capital city, Lusaka (32%, 19/60). Most had received prenatal care (91%, 57/61), and 80% (47/59) reported folate use in pregnancy. Of the mothers who took folate during pregnancy, 24% (11/45) reported use within the first 4 weeks after conception, while 76% (34/45) started thereafter. Myelomeningocele was the most common NTD (74%, 32/43), followed by meningocele (14%, 6/43). Prior to the educational program, 52% (29/56) of caregivers reported that NTDs were caused by a vitamin deficiency, which improved to 98% (55/56) after the program (p < 0.001). Furthermore, only 54% (33/61) of caregivers believed that folate should be taken before conception on the baseline survey evaluation, which improved to 95% (58/61, p < 0.001) after the program. All survey participants (58/58) found the educational session helpful. CONCLUSIONS This study found that a high proportion of Zambian caregivers had received prenatal care and even had taken folate during pregnancy, but none had taken it prior to pregnancy. An educational program effectively improved understanding about the role and timing of perinatal folate administration in NTD prevention. This result also emphasizes the need for folate fortification and folate education for not only mothers but also primary care providers.
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Affiliation(s)
- Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville, Tennessee
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Nathan A Shlobin
- 3Northwestern University School of Medicine, Northwestern University, Chicago, Illinois
| | - Arnold Bhebhe
- 4Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Shilin Zhao
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
- 5Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- 6Department of Neurological Surgery, University of Alabama, Birmingham, Alabama
| | | | - Christopher M Bonfield
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
- Departments of8Neurological Surgery and
- 9Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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27
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Chanbour H, Suryateja Gangavarapu L, Chen JW, Bendfeldt GA, Younus I, Ahmed M, Roth SG, Luo LY, Chotai S, Abtahi AM, Stephens BF, Zuckerman SL. Unplanned Readmission After Surgery for Cervical Spine Metastases. World Neurosurg 2023; 171:e768-e776. [PMID: 36584895 DOI: 10.1016/j.wneu.2022.12.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/25/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patients undergoing surgery for cervical spine metastases are at risk for unplanned readmission due to comorbidities and chemotherapy/radiation. Our objectives were to: 1) report the incidence of unplanned readmission, 2) identify risk factors associated with unplanned readmission, and 3) determine the impact of an unplanned readmission on long-term outcomes. METHODS A single-center, retrospective, case-control study was undertaken of patients undergoing cervical spine surgery for metastatic disease between 02/2010 and 01/2021. The primary outcome of interest was unplanned readmission within 6 months. Survival analysis was performed for overall survival (OS) and local recurrence (LR). RESULTS A total of 61 patients underwent cervical spine surgery for metastatic disease with the following approaches: 11 (18.0%) anterior, 28 (45.9%) posterior, and 22 (36.1%) combined. Mean age was 60.9 ± 11.2 years and 38 (62.3%) were males. A total of 9/61 (14.8%) patients had an unplanned readmission, 3 for surgical reasons and 6 for medical reasons. No difference was found in demographics, preoperative Karnofsky Performance Scale (P = 0.992), motor strength (P = 0.477), or comorbidities (P = 0.213) between readmitted patients versus not. Readmitted patients had a higher rate of preoperative radiation (P = 0.009). No statistical differences were found in operative time (P = 0.893), estimated blood loss (P = 0.676), length of stay (P = 0.720), discharge disposition (P = 0.279), and operative approach (P = 0.450). Furthermore, no difference was found regarding complications (P = 0.463), postoperative Karnofsky Performance Scale (P = 0.535), and postoperative Modified McCormick Scale (P = 0.586). Lastly, unplanned readmissions were not associated with OS (log-rank; P = 0.094) or LR (log-rank; P = 0.110). CONCLUSIONS In patients undergoing cervical spine metastasis surgery, readmission occurred in 15% of patients, 33% for surgical reasons, and 67% for medical reasons. Preoperative radiotherapy was associated with an increased rate of unplanned readmissions, yet readmission had no association with OS or LR.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | | | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mahmoud Ahmed
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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28
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Chen JW, Heidsma CM, Engelsman AF, Kabaktepe E, van Dieren S, Falconi M, Besselink MG, Nieveen van Dijkum EJM. Clinical Prediction Models for Recurrence in Patients with Resectable Grade 1 and 2 Sporadic Non-Functional Pancreatic Neuroendocrine Tumors: A Systematic Review. Cancers (Basel) 2023; 15:cancers15051525. [PMID: 36900316 PMCID: PMC10001130 DOI: 10.3390/cancers15051525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Recurrence after resection in patients with non-functional pancreatic neuroendocrine tumors (NF-pNET) has a considerable impact on overall survival. Accurate risk stratification will tailor optimal follow-up strategies. This systematic review assessed available prediction models, including their quality. This systematic review followed PRISMA and CHARMS guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2022 for studies that developed, updated, or validated prediction models for recurrence in resectable grade 1 or 2 NF-pNET. Studies were critically appraised. After screening 1883 studies, 14 studies with 3583 patients were included: 13 original prediction models and 1 prediction model validation. Four models were developed for preoperative and nine for postoperative use. Six models were presented as scoring systems, five as nomograms, and two as staging systems. The c statistic ranged from 0.67 to 0.94. The most frequently included predictors were tumor grade, tumor size, and lymph node positivity. Critical appraisal deemed all development studies as having a high risk of bias and the validation study as having a low risk of bias. This systematic review identified 13 prediction models for recurrence in resectable NF-pNET with external validations for 3 of them. External validation of prediction models improves their reliability and stimulates use in daily practice.
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Affiliation(s)
- Jeffrey W. Chen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Center for Endocrine and Neuroendocrine Tumors (ACcENT), 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - Charlotte M. Heidsma
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Center for Endocrine and Neuroendocrine Tumors (ACcENT), 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Anton F. Engelsman
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Center for Endocrine and Neuroendocrine Tumors (ACcENT), 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Ertunç Kabaktepe
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Massimo Falconi
- Pancreatic Surgery, IRCCS Ospedale San Raffaele, Università Vita-Salute, 20132 Milan, Italy
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Els J. M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Center for Endocrine and Neuroendocrine Tumors (ACcENT), 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
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29
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Chen JW, Chanbour H, Roth SG, Stephens BF, Abtahi AM, Zuckerman SL. How Much Blood Loss Is Appropriate for a 2- to 3-Level Posterior Lumbar Fusion? Int J Spine Surg 2023; 17:241-249. [PMID: 36828635 PMCID: PMC10165640 DOI: 10.14444/8423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Despite the known association between higher estimated blood loss (EBL) and suboptimal outcomes, the threshold of EBL that negatively impacts outcomes following elective spine surgery remains unknown. In an open 2- and 3-level posterolateral lumbar fusion, we sought to find a threshold of surgeon-reported EBL associated with length of stay (LOS), 30-day complications, and patient-reported outcomes (PROs). METHODS A single-center, retrospective cohort study was performed for 2- and 3-level open posterolateral lumbar fusions between October 2010 and April 2021. Surgeon-reported EBL (milliliters) was the primary independent variable for predicting LOS (days). Secondary outcomes included 30-day complications and PROs as the minimal clinically important difference (MCID). Multivariable regression and receiver operating characteristic curve with Youden's Index were calculated. RESULTS 2-Level Fusion: A total of 557 patients underwent 2-level fusions. Multivariable regression found EBL to be a significant risk factor for prolonged LOS. A threshold of 375 mL was associated with LOS beyond postoperative day 2 (POD2) (area under the curve [AUC] = 0.64, 95% CI 0.58-0.70, P < 0.001). 3-Level Fusion: A total of 287 patients underwent 3-level fusions. Similarly, EBL was a significant risk factor for prolonged LOS, with a threshold of 675 mL to predict LOS beyond POD2 (AUC = 0.63, 95% CI 0.54-0.73, P = 0.012). EBL was associated with increased odds of 30-day complications, with a threshold of 538 mL (AUC = 0.63, 95% CI 0.51-0.76, P < 0.001). For both 2- and 3-level fusions, EBL was not significantly associated with MCID for any of the PROs. CONCLUSIONS In patients undergoing open, posterolateral lumbar fusions, surgeon-reported EBL thresholds at 375 mL for 2-level fusions and 675 mL for 3-level fusions were moderately associated with LOS beyond POD2. In 3-level lumbar fusions, EBL above 538 mL showed a potential association with an increased odds of 30-day complications. CLINICAL RELEVANCE Surgeons should improve their ability to manage blood loss and implement methods to keep EBL below the provided thresholds to decrease LOS and minimize the risk of complications. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt University School of Medicine, Nashville, TN, USA .,Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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30
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Chen JW, van Ramshorst TME, Lof S, Al-Sarireh B, Bjornsson B, Boggi U, Burdio F, Butturini G, Casadei R, Coratti A, D'Hondt M, Dokmak S, Edwin B, Esposito A, Fabre JM, Ferrari G, Ftériche FS, Fusai GK, Groot Koerkamp B, Hackert T, Jah A, Jang JY, Kauffmann EF, Keck T, Manzoni A, Marino MV, Molenaar Q, Pando E, Pessaux P, Pietrabissa A, Soonawalla Z, Sutcliffe RP, Timmermann L, White S, Yip VS, Zerbi A, Abu Hilal M, Besselink MG. Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study. Ann Surg Oncol 2023; 30:3023-3032. [PMID: 36800127 PMCID: PMC10085922 DOI: 10.1245/s10434-022-13054-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. METHODS An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010-2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. RESULTS In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. CONCLUSIONS In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials.
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Affiliation(s)
- Jeffrey W Chen
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tess M E van Ramshorst
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Sanne Lof
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Bergthor Bjornsson
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa, Pisa, Italy
| | - Fernando Burdio
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | | | - Riccardo Casadei
- Department of Surgery, Sant'Orsola Malphigi Hospital, Bologna, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - Bjørn Edwin
- The Intervention Center, Department of Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Jean M Fabre
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | | | - Fadhel S Ftériche
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Asif Jah
- Department of HPB Surgery and Transplantation, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | | | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Alberto Manzoni
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco V Marino
- Department of Emergency and General Surgery, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elizabeth Pando
- Department of Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Patrick Pessaux
- Department of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham, Birmingham, UK
| | | | - Steven White
- Department of Surgery, The Freeman Hospital, Newcastle Upon Tyne, Newcastle, UK
| | - Vincent S Yip
- Department of HPB Surgery, The Royal London Hospital, Bartshealth NHS Trust, London, UK
| | - Alessandro Zerbi
- Department of Surgery, Humanitas University and IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Marc G Besselink
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
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van Ramshorst TME, Chen JW, Abu Hilal M, Besselink MG. ASO Author Reflections: The Safety and Efficacy of Robot-Assisted and Laparoscopic Distal Pancreatectomy in Patients with Resectable Left-Sided Pancreatic Cancer. Ann Surg Oncol 2023; 30:3033-3034. [PMID: 36745254 PMCID: PMC10085914 DOI: 10.1245/s10434-023-13171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Tess M E van Ramshorst
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Department of General Surgery, Department of Hepato-biliary and Pancreatic Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Jeffrey W Chen
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mohammad Abu Hilal
- Department of General Surgery, Department of Hepato-biliary and Pancreatic Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Chanbour H, Chen JW, Roth SG, Stephens BF, Abtahi AM, Zuckerman SL. How Much Blood Loss Is Too Much for a 1-Level Open Lumbar Fusion? Int J Spine Surg 2023; 17:146-155. [PMID: 36754572 PMCID: PMC10025837 DOI: 10.14444/8395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Despite the known association between increased estimated blood loss (EBL) and suboptimal perioperative outcomes, the exact threshold of EBL that impacts outcomes following elective spine surgery remains unknown. In a cohort of patients undergoing elective 1-level open posterior lumbar fusion, we sought to identify EBL thresholds associated with: (1) prolonged length of stay (LOS), (2) postoperative complications, and (3) patient-reported outcomes (PROs). METHODS A retrospective, single-center study was performed of patients undergoing elective, 1-level open posterior lumbar fusion with and without interbody fusion between October 2010 and April 2021. The primary exposure variable was EBL. Primary outcomes included: (1) LOS, (2) 30-day complications, and (3) 3-month PROs. Minimum clinically important difference was set at 30% improvement from baseline. For purposes of receiver-operating characteristic curves, LOS was dichotomized as 1 vs ≥2 days. RESULTS Of the 2028 patients undergoing posterior lumbar fusion surgery, 1183 underwent 1-level fusions, 763 (64.5%) with interbody fusion and 420 (35.5%) without. With interbody fusion: Median (interquartile range [IQR]) EBL was 350 mL (200-600), and median (IQR) LOS was 2 days (2-3). A positive linear association was found between EBL and LOS (P < 0.001) but not with PROs. EBL above 275 mL was associated with LOS beyond postoperative day 1 (POD1) (area under the curve [AUC] = 0.73, 95% CI 0.68-0.78, P < 0.001), with no significant association with overall complications or PROs. Without interbody fusion: Median EBL (IQR) was 300 mL (150-500), and median (IQR) LOS was 3 days (2-4). A positive linear association was found between EBL and LOS (P < 0.001) but not with PROs. EBL above 238 mL was associated with LOS beyond POD1 (AUC = 0.78, 95% CI 0.71-0.85, P < 0.001), with no impact on overall complications or PROs. CONCLUSIONS In patients undergoing 1-level posterior lumbar fusion, EBL volumes greater than 275 and 238 mL in patients with and without interbody fusion, respectively, were associated with increased LOS beyond POD1. No effect was found regarding 30-day complications and 3-month PROs. Although EBL did not directly impact complications or PROs, surgeons may expect longer LOS when higher EBL is reported. CLINICAL RELEVANCE EBL above 275 mL with an interbody and 238 mL without an interbody were associated with prolonged LOS beyond POD1 in 1-level open lumbar fusion. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W Chen
- Vanderbilt University, School of Medicine, Nashville, TN, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Rosinsky PJ, Chen JW, Glein RM, Jimenez AE, Brayboy C, Domb BG. Lateral to Medial Joint Space Ratio is Predictive of Survivorship After Primary Hip Arthroscopy. Arthroscopy 2023; 39:300-307. [PMID: 35810975 DOI: 10.1016/j.arthro.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether preoperative joint space measures would be predictive of survivorship in patients undergoing hip arthroscopy (HA) for femoroacetabular impingement (FAI). METHODS Data on consecutive patients who underwent hip arthroscopy between February 2008 and February 2018 were retrospectively reviewed. To be eligible for final analysis, patients were required to have preoperative radiographs for joint space measurements and data indicating conversion to a total hip arthroplasty (THA), hip resurfacing, or neither; at a minimum of 2 years after primary hip arthroscopy. Survivorship following HA was defined as remaining conversion free and served as the primary outcome. A multivariate logistic regression analysis and receiver operator curve (ROC) were used to evaluate the correlation between joint space measurements and survivorship following HA. RESULTS A total of 1,885 primary arthroscopy cases were included in this study. The multivariate regression analysis found preoperative lateral-to-medial joint space ratio (L/M ratio) to be the strongest predictive factor of survivorship after primary hip arthroscopy (OR = 2.084, CI95% = 1.239-3.503; P = .006). The ROC curve for the model demonstrated acceptable discrimination with an area under the curve (AUC) of 0.792. Patients with an L/M ratio ≥0.75 had a survivorship rate of 91.7% compared to a rate of 75% for patients with an L/M ratio <0.75 (OR: 3.68). CONCLUSIONS This study found that, of the factors evaluated in this study, the most significant factor in predicting survivorship at 2 years after undergoing primary hip arthroscopy was a larger lateral-to-medial joint space ratio. This may suggest an initiation of primary arthritis at the edge-loading area of the lateral acetabulum. LEVEL OF EVIDENCE: III, retrospective comparative observation study.
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Affiliation(s)
- Philip J Rosinsky
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jeffrey W Chen
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ciaran Brayboy
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A; American Hip Institute, Chicago, Illinois, U.S.A..
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Xiao ZJ, Chen JW, Wang Y, Wang ZY. In silico package models for deriving values of solute parameters in linear solvation energy relationships. SAR QSAR Environ Res 2023; 34:21-37. [PMID: 36625152 DOI: 10.1080/1062936x.2022.2162576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Environmental partitioning influences fate, exposure and ecological risks of chemicals. Linear solvation energy relationship (LSER) models may serve as efficient tools for estimating environmental partitioning parameter values that are commonly deficient for many chemicals. Nonetheless, scarcities of empirical solute parameter values of LSER models restricted the application. This study developed and evaluated in silico methods and models to derive the values, in which excess molar refraction, molar volume and logarithm of hexadecane/air partition coefficient were computed from density functional theory; dipolarity/polarizability parameter, solute H-bond acidity and basicity parameters were predicted by quantitative structure-activity relationship models developed with theoretical molecular descriptors. New LSER models on four physicochemical properties relevant with environmental partitioning (n-octanol/water partition coefficients, n-octanol/air partition coefficients, water solubilities, sub-cooled liquid vapour pressures) were constructed using the in silico solute parameter values, which exhibited comparable performance with conventional LSER models using the empirical solute parameter values. The package models for deriving the LSER solute parameter values, with advantages that they are free of instrumental determinations, may lay the foundation for high-throughput estimating environmental partition parameter values of diverse organic chemicals.
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Affiliation(s)
- Z J Xiao
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian Key Laboratory on Chemicals Risk Control and Pollution Prevention Technology, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - J W Chen
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian Key Laboratory on Chemicals Risk Control and Pollution Prevention Technology, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Y Wang
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian Key Laboratory on Chemicals Risk Control and Pollution Prevention Technology, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
| | - Z Y Wang
- Key Laboratory of Industrial Ecology and Environmental Engineering (Ministry of Education), Dalian Key Laboratory on Chemicals Risk Control and Pollution Prevention Technology, School of Environmental Science and Technology, Dalian University of Technology, Dalian, China
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Chen JW, Yengo-Kahn A, Chotai S, Bhamidipati A, Smith C, Davis P, Reynolds RA, Boyd MP, Barrett TW, Compton ES, Dennis BM, Norris MS, Patel MB, Schwarz JP, Thomason NR, Thompson RC, Guillamondegui OD. Assessment of safety and effectiveness of non-neurosurgical management for minimal traumatic brain injury (TBI). Injury 2023; 54:82-86. [PMID: 36028374 DOI: 10.1016/j.injury.2022.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with mild traumatic brain injury (TBI) and intracranial hemorrhage often receive neurosurgical consultation. However, only a small proportion of patients require intervention. Our hypothesis is that low-risk minimal TBI patients managed without immediate neurosurgical consultation will have a reasonable safety and effectiveness outcome profile. METHODS A non-neurosurgical management protocol for adult minimal TBI was implemented at a level I trauma center as an interdisciplinary quality-improvement initiative in November 2018. Minimal TBI was defined as Glasgow Coma Scale (GCS) of 15 secondary to blunt mechanism, without anticoagulant or antiplatelet therapy, and isolated pneumocephalus and/or traumatic subarachnoid hemorrhage on head CT imaging. Safety was assessed by in-hospital mortality, neurosurgical interventions, and ED revisits within two weeks of discharge. Effectiveness was assessed by neurosurgical consult rate and length of stay. Outcomes were compared 8-months pre- and post-protocol implementation. RESULTS A total of 97 patients were included, of which 49 were pre-protocol and 48 were post-protocol There was no difference in rates of in-hospital mortality [0 (0%) vs 0 (0%)], neurosurgical procedure [1 (2.1%) vs 0 (0%)], operations [0 (0%) vs 0 (0%)], and ED revisits [1 (2.0%) vs 2 (4.2%), p = 0.985] between the periods. There was a significant reduction in neurosurgical consults post-protocol implementation (92% vs 29%, p<0.001). CONCLUSION A protocol for minimal TBI patients effectively reduced neurosurgical consultation without changes in safety profile. Such an interdisciplinary management protocol for low-risk neurotrauma can effectively utilize the neurosurgery consult services by stratifying neurologically stable TBI patient.
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Affiliation(s)
- Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Aaron Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States.
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States
| | | | - Candice Smith
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States
| | - Philip Davis
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Rebecca A Reynolds
- Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States
| | - Mary Peyton Boyd
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Tyler W Barrett
- Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth S Compton
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States
| | - Bradley M Dennis
- Vanderbilt University School of Medicine, Nashville, TN, United States; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States
| | - Michael S Norris
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States
| | - Mayur B Patel
- Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States; Surgical Services, Geriatric Research Education and Clinical Centers, Tennessee Valley Healthcare System, United States Department of Veterans Affairs, Nashville, TN, United States; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt Brain Institute, United States
| | - Jacob P Schwarz
- Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States
| | - Nicholas R Thomason
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States
| | - Reid C Thompson
- Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States
| | - Oscar D Guillamondegui
- Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Neurological Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN United States; Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, United States.
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Chanbour H, Chen JW, Dewan MC, Zuckerman SL. Commentary: Dura Management Strategies in the Surgical Treatment of Adult Chiari Type I Malformation: A Retrospective, Multicenter, Population-Based Parallel Cohort Case Series. Oper Neurosurg (Hagerstown) 2022; 23:e342-e343. [DOI: 10.1227/ons.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
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Chen JW, Zhang ZM, Yan LL, Zhao YH, Song JZ, Liu X, Zhao H, Zhang H. [Research progress in the application of non-thermal atmospheric pressure plasma in dentin bonding]. Zhonghua Kou Qiang Yi Xue Za Zhi 2022; 57:880-883. [PMID: 35970786 DOI: 10.3760/cma.j.cn112144-20220301-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As a convenient and effective surface modification approach, non-thermal atmospheric pressure plasma (NTAPP)can be used to improve dentin bonding, and has recently become a research focus. Studies have shown that NTAPP can alter dentin surface properties, improve the penetration and polymerization of adhesives, stimulate the cross-linking of collagen, and change the micro-morphology and element content of dentin surface, thus improve the dentin bonding quality. This article introduces the current research progress in the application of NTAPP in the field of dentin bonding, in order to provide innovative information for future research in optimization of the quality of dentin bonding.
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Affiliation(s)
- J W Chen
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Z M Zhang
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - L L Yan
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - Y H Zhao
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - J Z Song
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - X Liu
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - H Zhao
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
| | - H Zhang
- Department of Endodontics, Hospital of Stomatology, Jilin University, Changchun 130021, China
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Tang AR, Chen JW, Sellyn GE, Chen H, Zhao S, Gannon SR, Shannon CN, Bonfield CM. Evaluating caregiver stress in craniosynostosis patients. J Neurosurg Pediatr 2022; 30:1-8. [PMID: 35561696 DOI: 10.3171/2022.4.peds21596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Caregiver stress from a child's diagnosis can impact a caregiver's ability to participate in treatment decisions, comply, and manage long-term illness. The aim of this study was to compare caregiver stress in children with craniosynostosis at diagnosis and postoperatively. METHODS This prospective study included caregivers of pediatric patients with craniosynostosis receiving operative intervention. Demographics and Parenting Stress Index, Short Form (PSI-SF) and Pediatric Inventory for Parents (PIP) surveys at baseline (preoperatively) and 3 and 6 months postoperatively were completed. PSI-SF scores between 15 and 80 are considered normal, with > 85 being clinically significant and requiring follow-up. Higher PIP scores represent increased frequency and difficulty of stressful events due to the child's illness. Pairwise comparisons were performed using the Wilcoxon signed-rank test. Multivariate analysis was performed to assess for PSI-SF and PIP predictors. RESULTS Of 106 caregivers (84% Caucasian), there were 62 mothers and 40 fathers. There were 68 and 45 responses at 3 and 6 months postoperatively, respectively. Regarding the baseline group, more than 80% were between 20 and 40 years of age and 58% had less than 2 years of college education. The median household income fell in the $45,001-$60,000 bracket. There was no significant difference between median baseline PSI-SF score (65, IQR 51-80) and those at 3 months (p = 0.45) and 6 months (p = 0.82) postoperatively. Both median PIP frequency (89 vs 74, p < 0.01) and difficulty (79 vs 71, p < 0.01) scores were lower at 3 months, although no significant difference was observed at 6 months (frequency: 95 vs 91, p = 0.67; difficulty: 82 vs 80, p = 0.34). Female sex, uninsured status, and open surgery type were all risk factors for higher parental stress. CONCLUSIONS Stress levels ranged from normal to clinically significant in the caregivers, with sex, uninsured status, and open repair predicting higher stress. Stress decreased at 3 months postoperatively before increasing at 6 months. Intervention targeting caregiver stress should be explored to maintain lower stress observed at 3 months after surgery.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Georgina E Sellyn
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Heidi Chen
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Shilin Zhao
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Stephen R Gannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Chevis N Shannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Shapira J, Chen JW, Yelton MJ, Rosinsky PJ, Maldonado DR, Meghpara MB, Lall AC, Domb BG. The Inverse Relationship Between Labral Size and Acetabular Coverage: Does It Protect the Cartilage in the Dysplastic Hip? Arthroscopy 2022; 38:385-393. [PMID: 33964389 DOI: 10.1016/j.arthro.2021.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to confirm the relationship between osseous coverage and labral size and to investigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size. METHODS Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements: lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants: anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with average labral size in the bottom quartile. RESULTS A total of 1765 hips (1589 patients) were included in the study. The mean LCEA, Ax, and ACEA between the borderline dysplastic and nondysplastic groups were significantly different (P < .001). According to the Ax classification, there was significant evidence that borderline dysplastic hips had larger labra (P < .05). Among the dysplastic group, there was significantly more cartilage damage according to the Outerbridge classifications along both the acetabulum and femoral head in hips with labra in the upper quartile (P =.011 and .005, respectively). CONCLUSION An inverse relationship may exist between acetabular depth and labral size. Additionally, specifically in borderline dysplastic hips, a relatively large labrum correlates with worse intra-articular damage compared to borderline dysplastic hips with a relatively small labrum. Larger labral size may indicate a higher degree of instability in patients with borderline dysplasia. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
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Manawasinghe IS, Calabon MS, Jones EBG, Zhang YX, Liao CF, Xiong YR, Chaiwan N, Kularathnage ND, Liu NG, Tang SM, Sysouphanthong P, Du TY, Luo M, Pasouvang P, Pem D, Phonemany M, Ishaq M, Chen JW, Karunarathna SC, Mai ZL, Rathnayaka AR, Samarakoon MC, Tennakoon DS, Wijesinghe SN, Yang YH, Zhao HJ, Fiaz M, Doilom M, Dutta AK, Khalid AN, Liu JW, Thongklang N, Senanayake IC, Tibpromma S, You LQ, Camporesi E, Gafforov YS, Hyde KD KD. Mycosphere notes 345–386. MYCOSPHERE 2022. [DOI: 10.5943/mycosphere/13/1/3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Steinle AM, Chen JW, O'Brien A, Vaughan WE, Croft AJ, Waddell WH, Vickery J, Elrod RW, Chanbour H, Lugo-Pico J, Zuckerman SL, Abtahi AM, Stephens BF. Efficacy and Safety of the Ultrasonic Bone Scalpel in Lumbar Laminectomies. Spine Surg Relat Res 2022. [DOI: 10.22603/ssrr.2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Jeffrey W. Chen
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Alexander O'Brien
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Wilson E. Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Andrew J. Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - W. Hunter Waddell
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Justin Vickery
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Robert W. Elrod
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Julian Lugo-Pico
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | | | - Amir M. Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Byron F. Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center
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Wu XH, Liu Y, Han L, Chen JW. [Spindle cell type follicular adenoma of thyroid: report of a case]. Zhonghua Bing Li Xue Za Zhi 2021; 50:1283-1285. [PMID: 34719173 DOI: 10.3760/cma.j.cn112151-20210302-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- X H Wu
- Department of Pathology, People's Hospital of Three Gorges University,the First People's Hospital of Yichang, Yichang 443000, Hubei Province, China
| | - Y Liu
- Department of Pathology, Yiling Hospital, Yichang 443100, Hubei Province, China
| | - L Han
- Department of Pathology, People's Hospital of Three Gorges University,the First People's Hospital of Yichang, Yichang 443000, Hubei Province, China
| | - J W Chen
- Department of Pathology, People's Hospital of Three Gorges University,the First People's Hospital of Yichang, Yichang 443000, Hubei Province, China
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Haizel-Cobbina J, Chen JW, Belete A, Dewan MC, Karekezi C. The landscape of neuro-oncology in East Africa: a review of published records. Childs Nerv Syst 2021; 37:2983-2992. [PMID: 34468839 DOI: 10.1007/s00381-021-05344-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Primary central nervous system (CNS) tumors represent an important and growing cause of worldwide morbidity and mortality. There are global variations in the reported case burden of CNS tumors, with high-income countries reporting a higher incidence of cases than low- and middle-income countries. Variations are attributed to differences in access to care, diagnostic capacity, risk exposure, and under-reporting in LMICs. This study aims to review existing literature on the distribution of primary CNS tumors and neuro-oncologic care, and the contribution of scientists and institutions to neuro-oncologic research across 18 East African countries over the last 5 decades. METHOD A search was conducted using OVID Medline and PubMed databases to identify relevant East African neuro-oncologic studies published over the last 50 years. RESULTS The authors reviewed 36 neuro-oncology articles published across 8 of 18 East African countries. Kenya represented the highest number of published articles; ten countries queried yielded zero publications. A total of 2006 cases from all age groups were represented in published literature consisting of a wide spectrum of CNS tumors. One-third of reported cases were pediatric. Meningioma formed the largest proportion (43.3%) followed by glioma (33.7%). Sixty-seven percent of publications gave an overview of clinical care received by patients with most patients not receiving comprehensive neuro-oncologic care. CONCLUSION The modest collection of neuro-oncology publications from East Africa shows that the case diversity of primary CNS tumors in East Africa is comparable to the rest of the world. There is, however, poorer access to neurosurgical care and adjuvant therapy. Multidisciplinary efforts from clinicians, researchers, and healthcare agencies are needed to quantify and address the requisite neuro-oncology needs in this region.
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Affiliation(s)
- Joseline Haizel-Cobbina
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Michael C Dewan
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Claire Karekezi
- Department of Surgery, Neurosurgery Unit, Rwanda Military Hospital, Kigali, Rwanda
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Chen JW, Lu JY, Zhang R, Cai JC. [Antibiotic resistance and virulence characteristics analysis of a carbapenem-resistant hypervirulent Klebsiella pneumoniae]. Zhonghua Yi Xue Za Zhi 2021; 101:2478-2484. [PMID: 34399563 DOI: 10.3760/cma.j.cn112137-20201119-03143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To characterize the antibiotic resistance and virulence in a carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods: A CRKP (designated K. pneumoniae C35) was isolated from a stool sample. The minimal inhibitory concentrations of antimicrobial agents were determined using the broth microdilution method. Whole-genome sequencing and genome analysis were performed to identify the antibiotic resistance and virulence genes. The genetic relationship among K. pneumoniae C35 and other CRKP isolates from our hospital was analyzed by single nucleotide polymorphism (SNP) typing of core genomes. Conjugation experiments were carried out by filter mating to evaluate the transferability and efficiency of resistance genes. The virulence phenotype was determined by Galleria mellonella infection model. Results: K. pneumoniae C35 exhibited resistance to the majority of tested antibiotics, especially carbapenems, sulbactam, and polymyxins. SNP typing showed that K. pneumoniae C35 shared a high degree of sequence homology with several CRKP isolates from different wards. This ST11 CRKP carried 13 resistance genes, including blaKPC-2, blaCTX-M-199, mcr-1, and tet(A) variant. blaKPC-2 gene was located on an IncFⅡ plasmid with>69 800 bp in size, blaCTX-M-199 and mcr-1 genes were located on an IncI2 plasmid (>64 800 bp), and tet(A) variant was located on an unknown Inc-type plasmid (83 628bp). All these three plasmids were conjugative. K. pneumoniae C35 was found to harbor rmpA, rmpA2, and iucABCD aerobactin-related genes, and was considered to be classic carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP). The virulence potential of this strain was confirmed in a Galleria mellonella infection model. The survival rate of the larvae injected with strain C35 at 48 h after infection was significantly lower than that of negative control strain (16.7% vs 80.0%). Conclusion: Multiple conjugative plasmids are identified in a faecal CR-hvKP. The IncI2 plasmid co-carrying both blaCTX-M-199 and mcr-1 genes is firstly identified in CR-hvKP. The emergence of such strain should be alerted and active surveillance is warranted.
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Affiliation(s)
- J W Chen
- Clinical Microbiology Laboratory, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - J Y Lu
- Clinical Microbiology Laboratory, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - R Zhang
- Clinical Microbiology Laboratory, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - J C Cai
- Clinical Microbiology Laboratory, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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Kaçmaz E, Chen JW, Tanis PJ, Nieveen van Dijkum EJM, Engelsman AF. Postoperative morbidity and mortality after surgical resection of small bowel neuroendocrine neoplasms: A systematic review and meta-analysis. J Neuroendocrinol 2021; 33:e13008. [PMID: 34235792 PMCID: PMC8459236 DOI: 10.1111/jne.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
Although small bowel resection is generally considered a low risk gastrointestinal procedure, this might not be true for small bowel neuroendocrine neoplasms (SB-NEN) as a result of potential central mesenteric involvement. We aimed to determine the reported morbidity and mortality after resection of SB-NEN in the literature and assess the effect of hospital volume on postoperative morbidity and mortality. A systematic review was performed by searching MEDLINE and Embase in March 2021. All studies reporting morbidity and/or mortality after SB-NEN resection were included. Pooled proportions of overall morbidity (Clavien-Dindo I-IV), severe morbidity (Clavien-Dindo III-IV), 30-day mortality, 90-day mortality and in-hospital mortality were calculated, as well as the association with hospital volume (high volume defined as the fourth quartile). Thirteen studies were included, with a total of 1087 patients. Pooled proportions revealed an overall morbidity of 13% (95% confidence interval [CI] = 7%-24%, I2 = 90%), severe morbidity of 7% (95% CI = 4%-14%, I2 = 70%), 30-day mortality of 2% (95% CI = 1%-3%, I2 = 0%), 90-day mortality of2% (95% CI = 2%-4%, I2 = 35%) and in-hospital mortality of 1% (95% CI = 0%-2%, I2 = 0%). An annual hospital volume of nine or more resections was associated with lower overall and severe morbidity compared to lower volume: 10% vs 15% and 4% vs 9%, respectively. Thirty-day mortality was similar (2% vs 1%) and 90-day mortality was higher in high-volume hospitals: 4% vs 1%. This systematic review with meta-analyses showed severe morbidity of 7% and low mortality rates after resection of SB-NEN. The currently available literature suggests a certain impact of hospital volume on postoperative outcomes, although heterogeneity among the included studies constrains interpretation.
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Affiliation(s)
- Enes Kaçmaz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam UMC, The Netherlands
| | - Jeffrey W Chen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam UMC, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam UMC, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam UMC, The Netherlands
| | - Anton F Engelsman
- Cancer Center Amsterdam, ENETS Center of Excellence, Amsterdam UMC, The Netherlands
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Domb BG, Chen JW, Kyin C, Bheem R, Karom J, Shapira J, Rosinsky PJ, Lall AC, Maldonado DR. Primary Robotic-Arm Assisted Total Hip Arthroplasty: An Analysis of 501 Hips With 44-Month Follow-up. Orthopedics 2021; 44:70-76. [PMID: 33561868 DOI: 10.3928/01477447-20210201-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to report patient-reported outcome measurements in a large group of patients who underwent robotic-arm assisted primary total hip arthroplasty (THA). Prospectively collected data were retrospectively reviewed between April 2012 and May 2017. Primary THAs using the Mako robotic-arm assisted (Mako Surgical Corp [Stryker]) with minimum 2-year follow-up for Harris Hip Score (HHS) and Forgotten Joint Score-12 (FJS-12) were included. Exclusion criteria were body mass index (BMI) of 40 kg/m2 or greater, age younger than 21 years, workers' compensation, or unwillingness to participate. Visual analog scale (VAS) score for pain and patient satisfaction score were obtained. Intraoperative measurements for leg length, global offset, acetabular inclination, and version were documented. A total of 501 hips were included, with 57.29% of the patients being female. Mean follow-up was 43.99±15.59 months. Mean age was 58.70±9.41 years. Mean BMI was 28.41±4.55 kg/m2. Mean HHS was 90.87±13.45, mean FJS-12 was 79.97±25.87, mean VAS score was 1.20±2.06, and mean patient satisfaction score was 8.85±2.08. Intraoperative values for acetabular inclination and version were 40.0°±2.2° and 20.5°±2.4°, respectively. The rate of revision due to instability was 0.2%. Patients who received primary robotic-arm assisted THA reported excellent results at 44-month follow-up for multiple patient-reported outcome measurements. Consistency in acetabular cup placement accuracy was achieved regarding the Lewinnek and Callanan safe zones. [Orthopedics. 2021;44(2):70-76.].
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Mayo BC, Miller A, Patetta MJ, Schwarzman GR, Chen JW, Haden M, Secretov E, Hutchinson MR. Preventing Tommy John Surgery: The Identification of Trends in Pitch Selection, Velocity, and Spin Rate Before Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Orthop J Sports Med 2021; 9:23259671211012364. [PMID: 34189147 PMCID: PMC8209837 DOI: 10.1177/23259671211012364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Ulnar collateral ligament (UCL) reconstruction is a common surgery among Major League Baseball (MLB) pitchers that results in a significant number of missed games. Little has been reported regarding game-by-game trends that can identify those on the verge of becoming injured. Purpose: To determine if there is a patterned change in MLB pitchers’ pitch selection, velocity, or spin rate in games leading up to Tommy John surgery that may predict subsequent UCL surgery. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of MLB pitchers who underwent primary UCL reconstruction between 2009 and 2019 was performed. Pitch characteristics were evaluated on a game-by-game basis for the 15 games leading up to surgery. A Mann-Kendall trend test was used to identify trends in pitch selection, velocity, and spin rate for multiple pitch types. A Kendall τb correlation coefficient was identified, with values closer to 1 or –1 signifying a stronger monotonic trend. Results: A total of 223 MLB pitchers underwent UCL reconstruction in the time period. In the 15 games leading up to surgery, decreases in pitch velocity for 4-seam fastballs (τb = –0.657; P < .001), 2-seam fastballs (τb = –0.429; P = .029), and sliders (τb = –0.524; P = .008) were significantly associated with game number closer to injury. There was a significant positive association in the spin rate for cutters (τb = 0.410; P = .038) and a significant negative association in spin rate for 4-seam fastballs over the course of these 15 games (τb = –0.581; P = .003). In addition, there was a significant positive association in the percentage of curveballs thrown (τb = 0.486; P = .013). Conclusion: The study results suggest that there is a patterned change in certain pitch statistics in MLB pitchers in the games leading up to Tommy John surgery. Although the absolute change from game to game may be small, it may be possible for these trends to be monitored before a player becomes injured, thus reducing the significant burden Tommy John surgery places on these athletes.
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Affiliation(s)
| | - Adam Miller
- University of Illinois at Chicago, Chicago, Illinois, USA
| | | | | | - Jeffrey W Chen
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marshall Haden
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Erwin Secretov
- University of Illinois at Chicago, Chicago, Illinois, USA
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Go CC, Kyin C, Chen JW, Domb BG, Maldonado DR. Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120987538. [PMID: 34250156 PMCID: PMC8239984 DOI: 10.1177/2325967120987538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a
treatment for femoroacetabular impingement (FAI) and labral tears. However,
there is less literature on whether the favorable results of hip arthroscopy
can justify the costs, especially when compared with a nonoperative
treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for
treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts
University Cost-Effectiveness Analysis Registry were searched to identify
articles that reported the cost per quality-adjusted life-year (QALY)
generated by hip arthroscopy. The key terms used were “hip arthroscopy,”
“cost,” “utility,” and “economic evaluation.” The threshold for
cost-effectiveness was set at $50,000/QALY. The Methodological Index for
Non-Randomized Studies instrument and Quality of Health Economic Studies
(QHES) score were used to determine the quality of the studies. This study
was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were
identified, and 5 of these studies compared hip arthroscopy to a
nonoperative comparator. These studies were found to have a mean QHES score
of 85.2 and a mean cohort age that ranged from 33-37 years. From both a
health care system perspective and a societal perspective, 4 studies
reported that hip arthroscopy was more costly but resulted in far greater
gains than did nonoperative treatment. The preferred treatment strategy was
most sensitive to duration of benefit, preoperative osteoarthritis, cost of
the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but
provided greater gain in QALYs than did a nonoperative treatment. In certain
cases, hip arthroscopy can be cost-effective given a long enough duration of
benefit and appropriate patient selection. However, there is further need
for literature to analyze willingness-to-pay thresholds.
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Affiliation(s)
- Cammille C Go
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wu JH, Chen JW, Chen MY, Chen YL. Response to the Letter to the Editor: "Carcinogenesis of Male Oral Submucous Fibrosis Alters Salivary Microbiomes". J Dent Res 2021; 100:558. [PMID: 33655776 DOI: 10.1177/00220345211000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J H Wu
- Department of Environmental Engineering, National Cheng Kung University, Tainan, Taiwan
| | - J W Chen
- Department of Environmental Engineering, National Cheng Kung University, Tainan, Taiwan
| | - M Y Chen
- Institute of Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Y L Chen
- Institute of Oral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Han W, Wang H, Cui N, Zhang JH, Bai GX, Chen JW, Long Y. [Diagnostic and prognostic value of peripheral lymphocyte subtyping for invasive candidiasis infection in critically ill patients with non-neutropenic sepsis]. Zhonghua Nei Ke Za Zhi 2021; 59:968-975. [PMID: 33256338 DOI: 10.3760/cma.j.cn112138-20200430-00440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the diagnostic and prognostic value of lymphocyte subtyping for invasive candidiasis infection (ICI) in critically ill patients with non-neutropenic sepsis. Methods: A prospective observational cohort study was performed at Peking Union Medical College Hospital (PUMCH), 377 patients with non-neutropenic sepsis admitted to Department of Critical Care Medicine from January 2017 to November 2019 were enrolled. There were 9.0% (34/377) patients diagnosed as ICI. Vital signs, supportive care therapy and microbiological specimens were collected. Peripheral blood lymphocyte subtypes, serum globulin, complements, inflammatory factors such as interleukin(IL)-6, IL-8, IL-10 and tumor necrosis factor were detected within 24 hours after sepsis was diagnosed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value and prognostic significance of immunological indicators for ICI. Multiple logistic regression was used to analyze the independent risk factors for ICI. Kaplan-Meier analysis was used to analyze survival. Results: The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 17.0 (13.0, 21.0) in all 377 patients. The sequential organ failure score (SOFA) was 11.0 (8.0, 13.0), and the 28-day mortality rate was 27.6% (104/377). Peripheral blood CD8+absolute T lymphocyte count≤177 cells/μl, CD28+CD8+T-cell count≤81 cells/μl and 1, 3-β-D-glucan (BDG) ≥88.20 ng/L were closely correlated with the diagnosis of ICI (AUC=0.793,95%CI 0.749-0.833,P<0.000 1;AUC=0.892,95%CI 0.856-0.921, P<0.000 1;AUC=0.761, 95%CI 0.715-0.803,P<0.000 1, respectively), with sensitivity of diagnosis 94.12%, 100.00%, and 88.24%; the specificity of diagnosis 81.34%, 62.39%, 63.56% respectively. Multivariate logistic regression analysis identified CD8+T-cell count≤139 cells/μl (OR=7.463, 95%CI 1.300-42.831, P=0.024) and CD28+CD8+T-cell counts≤52 cells/μl (OR=57.494, 95%CI 3.986-829.359, P=0.003) as independent risk factors for higher mortality. Kaplan-Meier survival analysis suggested that CD8+T-cell count ≤139 cells/μl (P=0.0159) and CD28+CD8+T-cell count≤52 cells/μl (P=0.000 1) were associated with higher mortality within 28 days (68.8%, 91.7%). Conclusions: Low CD28+CD8+T cell count in peripheral blood is closely related to the development and clinical outcome of ICI in sepsis patients, which could be used as an effective indicator for the diagnosis and prognosis prediction of ICI.
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Affiliation(s)
- W Han
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - N Cui
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J H Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - G X Bai
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J W Chen
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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